Texas 2009 - 81st Regular

Texas Senate Bill SB586 Compare Versions

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1	1	By: Carona, Deuell S.B. No. 586
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the operation of certain managed care plans regarding
7	7	out-of-network health care providers.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 843.306, Insurance Code, is amended by
10	10	adding Subsection (f) to read as follows:
11	11	(f) A health maintenance organization may not terminate
12	12	participation of a physician or provider solely because the
13	13	physician or provider informs an enrollee of the full range of
14	14	physicians and providers available to the enrollee, including
15	15	out-of-network providers.
16	16	SECTION 2. Subsection (a), Section 843.363, Insurance Code,
17	17	is amended to read as follows:
18	18	(a) A health maintenance organization may not, as a
19	19	condition of a contract with a physician, dentist, or provider, or
20	20	in any other manner, prohibit, attempt to prohibit, or discourage a
21	21	physician, dentist, or provider from discussing with or
22	22	communicating in good faith with a current, prospective, or former
23	23	patient, or a person designated by a patient, with respect to:
24	24	(1) information or opinions regarding the patient's
25	25	health care, including the patient's medical condition or treatment
26	26	options;
27	27	(2) information or opinions regarding the terms,
28	28	requirements, or services of the health care plan as they relate to
29	29	the medical needs of the patient; [or]
30	30	(3) the termination of the physician's, dentist's, or
31	31	provider's contract with the health care plan or the fact that the
32	32	physician, dentist, or provider will otherwise no longer be
33	33	providing medical care, dental care, or health care services under
34	34	the health care plan; or
35	35	(4) information regarding the availability of
36	36	facilities, both in-network and out-of-network, for the treatment
37	37	of the patient's medical condition.
38	38	SECTION 3. Section 1301.001, Insurance Code, is amended by
39	39	adding Subdivision (5-a) to read as follows:
40	40	(5-a) "Out-of-network provider" means a physician or
41	41	health care provider who is not a preferred provider.
42	42	SECTION 4. Subchapter A, Chapter 1301, Insurance Code, is
43	43	amended by adding Sections 1301.0051 and 1301.0052 to read as
44	44	follows:
45	45	Sec. 1301.0051. ACCESS TO OUT-OF-NETWORK PROVIDERS. An
46	46	insurer may not terminate, or threaten to terminate, an insured's
47	47	participation in a preferred provider benefit plan solely because
48	48	the insured uses an out-of-network provider.
49	49	Sec. 1301.0052. PROTECTED COMMUNICATIONS BY PREFERRED
50	50	PROVIDERS. (a) An insurer may not in any manner prohibit, attempt
51	51	to prohibit, penalize, terminate, or otherwise restrict a preferred
52	52	provider from communicating with an insured about the availability
53	53	of out-of-network providers for the provision of the insured's
54	54	medical or health care services.
55	55	(b) An insurer may not terminate the contract of or
56	56	otherwise penalize a preferred provider solely because the
57	57	provider's patients use out-of-network providers for medical or
58	58	health care services.
59	59	(c) A preferred provider terminated by an insurer is
60	60	entitled, on request, to all information on which the insurer
61	61	wholly or partly based the termination, including the economic
62	62	profile of the preferred provider, the standards by which the
63	63	provider is measured, and the statistics underlying the profile and
64	64	standards.
65	65	(d) An insurer's contract with a preferred provider may
66	66	require that, except in a case of a medical emergency as determined
67	67	by the preferred provider, before the provider may make an
68	68	out-of-network referral for an insured, the preferred provider
69	69	shall inform the insured:
70	70	(1) that:
71	71	(A) the insured may choose a preferred provider
72	72	or an out-of-network provider; and
73	73	(B) if the insured chooses the out-of-network
74	74	provider the insured may incur higher out-of-pocket expenses; and
75	75	(2) whether the preferred provider has a financial
76	76	interest in the out-of-network provider.
77	77	SECTION 5. (a) Except as provided by this section, the
78	78	changes in law made by this Act apply only to an insurance policy,
79	79	health maintenance organization contract, or evidence of coverage
80	80	delivered, issued for delivery, or renewed on or after January 1,
81	81	2010. A policy, contract, or evidence of coverage issued before
82	82	that date is governed by the law in effect immediately before the
83	83	effective date of this Act, and that law is continued in effect for
84	84	that purpose.
85	85	(b) Sections 843.306 and 843.363, Insurance Code, as
86	86	amended by this Act, and Section 1301.0052, Insurance Code, as
87	87	added by this Act, apply only to a contract between a health
88	88	maintenance organization or preferred provider benefit plan issuer
89	89	and a physician or health care provider that is entered into or
90	90	renewed on or after the effective date of this Act. A contract
91	91	entered into or renewed before the effective date of this Act is
92	92	governed by the law in effect immediately before the effective date
93	93	of this Act, and that law is continued in effect for that purpose.
94	94	SECTION 6. This Act takes effect September 1, 2009.
95	95	COMMITTEE AMENDMENT NO. 1
96	96	Amend S.B. 586 (senate engrossment), in SECTION 1 of the
97	97	bill, in added Section 843.306(f), Insurance Code, as follows:
98	98	(1) On page 1, line 11, before "out-of-network providers.",
99	99	insert "in-network and".
100	100	(2) On page 1, line 11, between "out-of-network providers"
101	101	and the period, insert ", and the enrollee chooses an
102	102	out-of-network provider".
103	103	81R31343 PMO-DHancock